Back January 28, 2018

The world’s best-known breast cancer experts weigh in on issues related to ER+ early stage breast cancer – Part 1

In a consensus report published last week, Endocrine therapy and related issues in hormone receptor‑positive early breast cancer: a roundtable discussion by the breast cancer therapy expert group (BCTEG), the BCTEG addressed four gaps in current guidance for oncologists related to the most common form of breast cancer, estrogen receptor positive (ER+) early stage breast cancer.

Intense discussion and ultimate agreement was reached on common yet confusing topics including –

  • What is the risk of contralateral breast cancer recurrence (breast cancer arising in the “other” breast after initial diagnosis) who have had 5 years of anti-estrogen therapy?
  • What are the adverse events from anti-estrogen treatment and how to best manage them?
  • What are the latest updates on and benefits from adjuvant bisphosphonate therapy?
  • How to think about the recent extended anti-estrogen treatment trial results and the use of biomarker tests to further inform treatment decisions?

The focus of today’s blog is this last segment. In an effort to provide guidance to the many thousands of oncologists who help women with breast cancer, the BCTEG said,

  • “All of these tests can be useful (at diagnosis) to identify patient subsets that have an extremely low risk of recurrence.”
  • “… at least one of these tests, BCI, has also been shown to predict response to endocrine therapy, and many participants reported having used BCI, at least on occasion (or more frequently) to further inform their treatment decisions for patients whose need for an additional 5 years of endocrine therapy was less certain (most notably, node-negative patients)”

Additionally, the BCTEG agreed on an official position regarding the use of multi-gene biomarker testing:

Expert Opinion Statement 1

Although further validation studies are needed, the use of multi-gene assays may provide important additional information that can guide treatment decisions; this information should be considered in the context of other clinicopathologic factors.

Expert Opinion Statement 2

Recently reported results from EA endocrine therapy trials suggest an overall modest benefit of extending endocrine therapy beyond 5 years; the currently available genomic biomarker assays may be useful to further inform treatment decisions in patients where uncertainty may exist (e.g., node-negative and/or poor tolerability).

These experts agree not only in words, but also through their actions, that Breast Cancer Index can help inform overall and late risk of recurrence and likelihood of benefit from extended endocrine therapy and should be considered in patients where there may be uncertainty. Please discuss questions regarding your individual situation directly with your doctor.

Be on the lookout for our recap of the other three important topics discussed and agreed to by the BCTEG!

References:

  1. Breast Cancer Research and Treatment:
    https://doi.org/10.1007/s10549-018-4662-9

Note: An unrestricted educational grant for this activity was provided by Biotheranostics, Inc.

– Breast Cancer Index Intended Use and Limitations –
The Breast Cancer Index (BCI) Risk of Recurrence & Extended Endocrine Benefit Test is intended for use in patients diagnosed with estrogen receptor-positive (ER+), lymph node-negative (LN-) or lymph node positive (LN+; with 1-3 positive nodes) early-stage, invasive breast cancer, who are distant recurrence-free. BCI provides: 1) a quantitative assessment of the likelihood of both late (post-5 years) and overall (0-10 year) distant recurrence following an initial 5 years of endocrine therapy (LN- patients) or 5 years of endocrine therapy plus adjuvant chemotherapy (LN+ patients), and 2) prediction of likelihood of benefit from extended (>5 year) endocrine therapy. BCI results are adjunctive to the ordering physician’s workup; treatment decisions require correlation with all other clinical findings.

This test was developed and its performance characteristics determined by Biotheranostics, Inc. lt has not been cleared or approved by the U.S. Food and Drug Administration. This test is used for clinical purposes. lt should not be regarded as investigational or for research. How this information is used to guide patient care is the responsibility of the physician. Biotheranostics is certified under the Clinical Laboratory lmprovement Amendments of 1988 to perform high complexity clinical laboratory testing.

For Breast Cancer Index Intended Use and Limitations, visit www.answersbeyond5.com.